Post-anesthesia care unit

Post-anesthesia care unit
A post-anesthesia care unit, often abbreviated PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply recovery, is a part of hospitals, ambulatory care centers, and other medical facilities. Patients who received general anesthesia, regional anesthesia, or local anesthesia are transferred from the operating room suites to the recovery area. The patients are monitored typically by anesthesiologists, nurse anesthetists, and other medical staff. Providers follow a standardized handoff to the medical PACU staff that includes, which medications were given in the operating room suites, how hemodynamics were during the procedures, and what is expected for their recovery. After initial assessment and stabilization, patients are monitored for any potential complications, until the patient is transferred back to their hospital rooms.
Initial handoff
The initial handoff, or otherwise referred as handover, is an interdisciplinary transfer of essential and critical patient information from one healthcare provider to another. Variations do exist depending on certain hospitals, medical facilities, and patient presentations. The most common information includes:
Patient Name and Date of Birth
Allergies, Past Medical History, Relevant Home Medications
Operating Room Course:
Preoperative medications received
Access for medications (IV lines, Gauges used, Locations)
Anesthetics Type
Airway, Relaxant, Reversal
Antibiotics, Analgesics, Antiemetics Administered
Other Medications
Fluids administered and volume status
Any Complications or concerns
Relevant information specific for patient's case for PACU staff to monitor
Specific recommendations for the post-anesthesia plan of care
Monitoring
As the patient remains in the PACU, the following are consistently monitored by medical professionals:
Vital signs (Heart Rate, Blood Pressure, Temperature, and Respiratory Rate)
Electrocardiogram
Saturation of Oxygen (SpO2)
Airway Patency
Mental Status
Neuromuscular Function
Postoperative pain
Surgical sites for excessive bleeding, mucopurulent discharge, swelling, hematomas, wound healing, and infection
Vital signs are obtained every 5 minutes for the first 15 minutes. The PACU staff monitor that the Respiratory Rate and Saturation of Oxygen remain as close to baseline of that patient while the heart rate and blood pressure remain within 20% of their baseline values.
More intensive care monitoring may include:
Preparation and education for the use of patient-controlled analgesia (PCA) units for postoperative pain control
Preparation and administration of intravenous, epidural, or perineural infusions
Invasive monitoring such as arterial lines, central venous lines, and ventriculostomies
Postoperative complications
Depending on the use of inhalation anesthestics, post operative nausea and vomiting (PONV) is one of the most common complications to monitor in the immediate postoperative period. Patients do receive antiemetic medications, such as Ondansetron and Dexamethasone, during the surgical procedure if the patient is at risk for it. Along with PONV, there are numerous complications that can happen with many different organ systems, the most threatening of which involves the respiratory system, and cardiovascular system.
Respiratory system/airway complications
Risk Factors are factored into account to assess for complications during the preoperative assessment. Some factors include preexisting factors such as chronic obstructive pulmonary disease (COPD), asthma, obstructive sleep apnea (OSA), obesity, heart failure, and pulmonary hypertension.
Clinical signs and symptoms are assessed to indicate any respiratory system complications, such as Tachypnea (RR > 20 breaths/min), Bradypnea (RR < 12 breaths/min), SpO2 <93%, Anxiety, Confusion, or Agitation with resulting Tachycardia and Hypertension.
The life-threatening complications that are monitored in PACU include:
Laryngospasm
Respiratory arrest
Airway Edema
Foreign Body
Cervical Hematoma
Bronchospasm
Pulmonary Edema
Tension Pneumothorax
Pulmonary Embolism
Atelectasis
Cardiovascular system complications
Cardiovascular complications such as arrhythmias and hemodynamic Instability are the third most common postoperative complication. The risk factors that are assessed preoperatively include the severity of any preexisting cardiovascular comorbidities, such as congestive heart failure, valvular heart disease, and myocardial infarctions. The medical professional also assesses if the patient has had any recent traumas and the severity of perioperative stresses such as blood loss, fluid shifts, and hypotension.
Clinical signs and symptoms are assessed to indicate any cardiovascular system complications, specifically hemodynamic instability and vital signs.
Hypotension
Patients who undergo major procedures that deal with volume status perioperatively can be at risk for hypotension due to fluid shifts or significant bleeding. Hemoglobin is measured and monitored if significant bleeding could have occurred. Treatment includes either replacement of the lost blood products as pRBC, or with crystalloid solutions while monitoring electrolyte abnormalities in Lactated Ringers Solution, Normal Saline, or Crystalloid. Patients can also experience life-threatening hypotensive shock due to hemorrhage, sepsis, cardiogenic, or anaphylactic.
See also
Aldrete's scoring system
Anesthesia
Anesthesiologist
Anesthetic technician
Intensive care unit
Nurse anesthetist
Operating department practitioner
References
Further reading
External links
Ketamine: Emergency Applications(eMedicine.com) - discusses laryngospasm.
Hospital departments
Anesthesia